Validation of the Perceived Implicit Rationing of Nursing Care ( PIRNCA ) Instrument

Background An inverse relationship between implicit rationing and quality patient outcomes has been demonstrated in European hospitals, but this relationship has not been explored in the U nited S tates. Objective To evaluate the psychometric properties of a new measure of implicit rationing, the P erceived I mplicit R ationing of N ursing C are ( PIRNCA ). Method A cross‐sectional survey design with a stratified random sample of 226 medical surgical nurses was used to evaluate the PIRNCA . The internal structure was evaluated using exploratory factor analysis. Pearson correlations were used to assess the associations between implicit rationing and three related constructs: work environment, overall job satisfaction, and quality of care. Results A single‐factor solution explaining 55% of the total variance and excellent reliability, C ronbach's alpha = 0.97, was supported for the PIRNCA . Moderate inverse relationships with related constructs provided evidence of concurrent validity: work environment (−0.44), overall job satisfaction (−0.48), and quality of care (−0.56). The majority of nurses (97%) reported rationing at least one of the 30 care activities listed; however, mean scores reflected a low frequency (“rarely”) of rationing overall. Conclusion The phenomenon of implicit rationing is experienced by nurses in U.S. hospitals, and the PIRNCA instrument is a valid and reliable measure of this phenomenon.